Systems and methods for patient alignment and treatment

ABSTRACT

A system for supporting and aligning a patient during a color alteration procedure includes a laser system that delivers a laser in a first direction. A control computer may be adjacent the laser system for controlling the laser system. The control computer system may include a user interface in a first plane substantially perpendicular to the first direction. The system may include a patient support structure having a patient support surface extending in a second direction substantially perpendicular to the first direction and configured to be adjustable to set a patient position or alignment relative to the laser system. Coarse adjustment hardware may be configured to cause automated and/or manual adjustments to the patient support surface in the first direction. Fine adjustment hardware may be configured to cause automated fine adjustments to the patient support surface in the first direction based on instructions received from the control computer.

RELATED APPLICATION(S)

This application is a continuation of U.S. patent application Ser. No.17/238,083, filed Apr. 22, 2022, which claims the benefit of priority ofU.S. Provisional Application No. 63/165,686, filed Mar. 24, 2021, titled“Systems and Methods for Patient Alignment and Treatment.” The contentof the foregoing applications is hereby incorporated herein in itsentirety by reference.

FIELD OF THE INVENTION

The invention relates to patient support systems suitable for medicalprocedures related to changing an eye color of a patient.

BACKGROUND

The use of lasers for eye surgery has increased recently. However, whilelaser eye surgery is a known option for the correction of one or morevision problems such as nearsightedness (myopia), farsightedness(hyperopia), and astigmatism, little interest has been shown tooperations other than those for correcting vision problems. For example,advancements in laser eye surgeries have focused on operations throughwhich a laser may reshape a patient's cornea and have ignored otherparts of a patient's eye and procedures therefor.

SUMMARY

In view of this, methods and systems are discussed herein for deliveringlaser light to an iris of a patient. In particular, the methods andsystems discussed herein are for performing an eye color changingprocedure through this delivery of laser light. For example, changing aperson's eye color may be performed by delivering laser light toportions of the eye that are responsible for giving the eye its color(e.g., the iris).

To achieve this effect, the methods and systems must overcome severaltechnical hurdles. For example, in conventional medical proceduresinvolving the eye (e.g., LASIK), it does not matter how the patient'shead is supported. Accordingly, it is natural for such procedures tohave the patient in an upright position whereby their head is supportedby their neck muscles. However, when the neck muscles are engaged, it isthe body's natural response to continuously have small movements of thehead (e.g., between 150-350 microns) along the optical axis of the eye.There may also be similar corresponding small changes in the orientationof the eye and that the persons head may rotate along one or more axesin the process of supporting the head via the neck muscles. Suchmovements may be detrimental to the disclosed eye color alterationprocedure. Thus, conventional head stabilization devices, while they mayprovide some assistance, still suffer from the problem that thepatient's neck muscles are engaged.

In view of these technical hurdles, the systems and methods discussedherein provide a patient support structure that allows neck muscles ofthe patient to be disengaged during the color alteration procedure. Alsodiscussed herein are related systems to facilitate the treatment,including, for example, having detached physician and technicianconsoles and methods for confirming the patient's identity prior to theprocedure via iris or retinal scans.

The systems and methods overcome the shortcomings of conventionalsystems by providing a patient support structure for setting a patientposition or alignment for performing the color alteration procedure.This may include, for example, an adjustable head support element thatmay cause the patient's head to be supported without engagement of theirneck muscles. The patient support structure may be configured to allowcoarse and/or fine adjustments of the patient's head and/or eye. Arangefinder may be included to determine precise distances between thelaser system and the iris, for proper patient positioning. Related tothis, there may be dedicated and detached physician and technicianconsoles that may control aspects of the procedure and/or displaypatient data. Image sensors may also be utilized to generate scans ofthe patient's iris or retina for patient identification, which alongwith patient medical record data, may be displayed at the consolesdescribed above.

In one aspect, a system for supporting and aligning a patient during acolor alteration procedure may include a laser system for performing thecolor alteration procedure. The laser system may deliver a laser in afirst direction. A control computer system may be adjacent to the lasersystem for controlling the laser system during the color alterationprocedure and may include a user interface in a first planesubstantially perpendicular to the first direction. The system may alsoinclude a patient support structure having a patient support surfaceextending in a second direction substantially perpendicular to the firstdirection and configured to be adjustable to set a patient position oralignment relative to the laser system. The patient support structuremay also have coarse adjustment hardware configured to cause automatedand/or manual adjustments to the patient support structure in the firstdirection. Similarly, the patient support structure may include fineadjustment hardware configured to cause automated fine adjustments tothe patient support surface in the first direction based on instructionsreceived from the control computer.

In another interrelated aspect, there may be a tangible, non-transitory,machine-readable medium storing instructions that, when executed by adata processing apparatus, causes the data processing apparatus toperform operations comprising those of any of the above methodembodiments.

In yet another interrelated aspect, a system may include one or moreprocessors and memory storing instructions that, when executed by theprocessors, cause the processors to effectuate operations comprisingthose of any of the above method embodiments.

Various other aspects, features, and advantages of the invention will beapparent through the detailed description of the invention and thedrawings attached hereto. It is also to be understood that both theforegoing general description and the following detailed description areexamples and not restrictive of the scope of the invention. As used inthe specification and in the claims, the singular forms of “a,” “an,”and “the” include plural referents unless the context clearly dictatesotherwise. In addition, as used in the specification and the claims, theterm “or” means “and/or” unless the context clearly dictates otherwise.Additionally, as used in the specification, “a portion” refers to a partof, or the entirety of (i.e., the entire portion), a given item (e.g.,data) unless the context clearly dictates otherwise.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a simplified diagram of the eye and iris.

FIG. 2 shows a simplified diagram of a laser system and patientpositioning system in accordance with one or more embodiments.

FIG. 3 shows a simplified patient support structure having an upperreclining portion in accordance with one or more embodiments.

FIG. 4 shows a view of the simplified patient support structure of FIG.3 with the upper reclining portion fully horizontal in accordance withone or more embodiments.

FIG. 5 shows a view of the simplified patient support structure of FIG.3 having an adjustable leg portion in accordance with one or moreembodiments.

FIG. 6 shows a simplified patient support structure with a head supportelement having an aperture in accordance with one or more embodiments.

FIG. 7 shows a simplified patient support structure as part of anadjustable seat in accordance with one or more embodiments.

FIG. 8 shows a simplified diagram of a system having laser system andimage sensor for use in rangefinding in accordance with one or moreembodiments.

FIG. 8A shows a simplified diagram of a rangefinder configured forperforming coarse resolution measurements in accordance with one or moreembodiments.

FIG. 8B shows a simplified diagram of a rangefinder configured forperforming fine resolution measurements in accordance with one or moreembodiments.

FIG. 9 shows a simplified system including detached physician andtechnician consoles in accordance with one or more embodiments.

FIG. 10 shows an illustrative system for performing an eye colorchanging procedure in accordance with one or more embodiments.

FIG. 11 shows a process for supporting and aligning a patient during acolor alteration procedure in accordance with one or more embodiments.

FIG. 12 shows a process for allowing the performance of an eye colorchanging procedure in accordance with one or more embodiments.

DETAILED DESCRIPTION OF THE DRAWINGS

In the following description, for the purposes of explanation, numerousspecific details are set forth in order to provide a thoroughunderstanding of the embodiments of the invention. It will beappreciated, however, by those having skill in the art, that theembodiments of the invention may be practiced without these specificdetails or with an equivalent arrangement. In other cases, well-knownstructures and devices are shown in block diagram form in order to avoidunnecessarily obscuring the embodiments of the invention.

The present disclosure provides improved methods and systems forfacilitating medical procedures to change the eye color of a patient.Such medical procedures may involve locating and aligning a patient(e.g., including the eye of the patient) in a proper manner that allowsaccurate delivery of laser light to portions of the eye such that abiological reaction occurs that alters the pigment structure of the eyeand thereby changes its color. Determining and maintaining the properposition and alignment to use based on the needs of the procedure,safety to the patient, and variations from patient to patient may becritical to a successful outcome. Also, to facilitate interaction withthe patient and efficient treatment delivery, the present disclosurecontains embodiments of separate and dedicated console(s) that may beutilized by a physician and/or a technician.

Before describing the color alteration procedure, which is applicable tomany embodiments of the present disclosure, a brief overview of theanatomy of the eye is provided. As shown in FIG. 1, eye 100 is composedof several anatomical structures, a few of which are discussed below.Central to the present disclosure, the iris 110 is responsible for thecolor of the eye. Other portions of the eye include, for example, cornea120, lens 130, pupil 140, and retina 150. While care should be taken toavoid damaging any part of the eye, in the practice of laser safety,special precautions should be taken to avoid directing unwanted laserlight through the pupil and into the lens as this part of the eyenaturally focuses light onto the retina. Such focusing of alreadyintense laser light may result in injury to the retinal nerves.

Shown in the insets above the eye are two examples of irises. Theexample on the left is a depiction of an iris 110 in a person with browneyes. The example on the right depicts an iris 110 of a person with blueor green eyes. The perceived color is due to light reaching the eyebeing separated into its component wavelengths by stromal fibers in themiddle region of the iris—referred to as the iris stroma 112. Theseparation is similar to the separation exhibited when light passesthrough a prism. In both cases, the iris has a posterior surface 114that contains a fairly thick (several cells deep) layer of pigmentationthat primarily absorbs visible light wavelengths longer than blue orgreen. However, in the example on the left for a person with brown eyes,there is an additional anterior surface that contains brown pigment,herein referred to as “stromal pigment” 116. The brown stromal pigmentgives the eye a brown color. Eyes without the stromal pigment reflectmostly blue or green light as described above, giving the eye a blue orgreen color.

A brief summary of a color alteration procedure as referenced herein isprovided. Laser light may be delivered to the stromal pigment to causean increase in temperature of the stromal pigment. This process may berepeated several times to repeatedly raise and lower the temperature ofthe stromal pigment. This raising and lowering of the temperature causesthe body to deploy macrophages (part of the body's natural immuneresponse) to the stromal layer. These macrophages then remove a portionof the stromal pigment responsible for giving the eye its brown color.Repeated procedures may be performed to provide varying degrees of colorchange to make the eye appear a deeper blue/green. The delivery of thelaser light may be in a scanning pattern (e.g., a spiral patternsurrounding the pupil or a raster pattern avoiding the pupil) to deliverthe treatment to the entire iris.

FIG. 2 shows a simplified diagram of a laser system and patientpositioning system in accordance with one or more embodiments. Oneembodiment of the overall system 200 may include the laser system 210and a patient positioning system 280. The head of patient 10 (with eyes100) is shown supported by the patient positioning system in a locationsuitable for the color alteration procedure. The laser system mayinclude the laser head 212 which provides laser light 214. The laserhead may include components to generate laser light at varyingwavelengths, for example, at 1064 nm or 532 nm (Nd:YLF or Nd:YAG).Exemplary pulse widths may be in the 5-300 ns with repetition rates of5-300 kHz and an M²≤1.2.

The laser head may include an energy source (aka a pump or pump source),a gain medium, and two or more mirrors that form an optical resonator.Exemplary energy sources include: electrical discharges; flashlamps; arclamps; output from another laser; and chemical reactions. Exemplary gainmedia include: liquids (e.g., dyes comprising chemical solvents andchemical dyes); gases (e.g., carbon dioxide, argon, krypton, andhelium-neon); solids (e.g., crystals and glasses, such asyttrium-aluminum garnet, yttrium lithium fluoride, sapphire,titanium-sapphire, lithium strontium aluminum fluoride, yttrium lithiumfluoride, neodymium glass, and erbium glass), which may be doped with animpurity (e.g., chromium, neodymium, erbium, or titanium ions) and maybe pumped by flashlamps or output from another laser; andsemiconductors, with uniform or differing dopant distribution (e.g.,laser diode).

Embodiments of the laser head may include an optical frequencymultiplier (e.g., a frequency doubler and sum-frequency generator),where the laser output frequency is increased by passing it through anon-linear crystal or other material. The benefit of an opticalfrequency multiplier is that it increases the range offrequencies/wavelengths available from a given gain medium. Thenon-linear material may be inserted into the optical resonator forone-step frequency multiplication, or the fundamental (i.e.,non-multiplied) output beam may be passed through the non-linearmaterial after leaving the optical resonator for two-step frequencymultiplication. Exemplary non-linear materials for frequency doublingmay include: lithium niobate, lithium tantalate, potassium titanylphosphate, or lithium triborate. Two-step frequency tripling istypically performed by frequency doubling a fraction of the fundamentaloutput beam in a first step. The doubled fraction of the fundamentalbeam and the non-doubled remainder of the fundamental beam are thencoupled into a second non-linear frequency tripling material in a secondstep for sum-frequency mixing. Exemplary non-linear materials forfrequency tripling may include potassium dihydrogen phosphate.

One combination of gain medium and optical frequency multiplier isNd:YAG with a frequency doubler. The natural harmonic of a laser beamgenerated by an Nd:YAG gain medium is a wavelength of 1,064 nm, which isthen halved to 532 nm by the frequency doubler. This wavelength may beutilized as: (a) it falls within the visible light spectrum (i.e.,green), thereby passing through the clear cornea with little or noabsorption; (b) it has a high absorption coefficient in stromal pigment,thereby effecting selective photothermolysis in the anterior stromalpigment of the iris; and (c) the wavelength is relatively short, therebylimiting the depth of penetration and avoiding unwanted damage to theIPE. Any other combination of gain media and optical frequencymultiplication that meets these three criteria is also may also beimplemented in some embodiments.

Laser pulse widths may be in the nanosecond range (i.e., from below 1nanosecond to 1 microsecond) and the pulse repetition rate may be in thekilohertz range (i.e., from below 1 kHz to 1 MHz). Some embodiments mayhave a pulse width between 5 ns and 300 ns, which may provide improvedpigment denaturation. Q-switching may be utilized as a preferred pulsingmethod as it tends to be optimally suited to the nanosecond pulse width.Some embodiments include active Q-switching with a modulator device.

As used herein, “laser” means any device capable of generating a beam ofoptical radiation, whether in the infrared, visible light, orultraviolet light spectrum. The term “laser” is not intended torestrict: (a) the properties of the optical radiation in terms ofmonochromaticity or coherence (e.g., divergence or directionality); (b)whether the radiation is continuous or pulsed; (c) if pulsed, thespecific pulse width (e.g., zeptosecond attosecond, femtosecond,picosecond, nanosecond, millisecond, or microsecond); (d) the repetitionrate; (e) the laser power; (f) the wavelength or frequency of the beam;(g) the number of wavelengths or frequencies, i.e., single v.multi-frequency output (e.g., intense pulsed light); (h) the number ofbeams, i.e., single v. multiple beams (e.g., splitting of a single beamor generating multiple beams from multiple lasers); or (i) the gainmedium.

As used herein, “laser power” may mean either W/cm² or J/cm², dependingon the context—as they are related by the exposure time. The MPE may beexpressed in either of those units. For example, MPE may include themaximum level of laser radiation to which a fundus may be exposedwithout hazardous effects or biological changes in the eye.

Accordingly, when the specification refers to a laser power in terms ofan MPE, the exact value of the laser power depends on, among otherthings, the beam spot size, pulse duration, or wavelength, and whetherthe laser is pulsed or continuous, etc. Thus, the determination of theMPE provides a basis for the skilled person to determine the laser powerin the various embodiments disclosed herein.

As used herein, when referring to “reducing,” “lowering,” “less,” etc.,in the context of adjusting the laser power, this is understood to meanthat the laser system may reduce the laser power from a current value toa lower (nonzero) value while still delivering laser light in somerespect. These definitions also include redirecting the laser beam(e.g., to a beam dump) such that the delivered laser power is reduced.These definitions also include turning off the laser system (i.e.,lowering the laser power to zero). Lastly, reducing the laser power mayalso include performing any of the above in a repetitive fashion therebylowering the duty cycle of the laser beam or performing any combinationof the above in an intermittent fashion.

Galvos systems 216 (also referred to as the x-y beam guidance system)may be included in the laser system and may include adjustable mirrorsto provide a means of delivering the laser light to various locations onan X-Y plane (typically the plane of the iris where the laser lightusually focused). Further implementations of the laser system mayinclude, for example rangefinders and/or optical tracking systems, whichmay include cameras to determine an X-Y deviation of the center of theeye relative to the optical axis of the laser system.

In some embodiments, the x-y beam guidance system may scan the beam spotabout the iris surface. The scanning parameters may include the size,shape, and position of the target region, the line and spot separationbetween each beam spot, and the predetermined scan pattern. The computerimaging software may determine the size, shape, and position of thetarget region based upon iris images captured by the x-y imaging systemand transmitted to the computer for processing. Once processed, thesize, shape, and position data may be transmitted to the scanningprogram to drive the x-y beam guidance system. New iris images may becaptured at predetermined intervals and transmitted to the computer forprocessing throughout the procedure. Captured images are compared, andif they indicate a change in iris position, the computer imagingsoftware calculates the x-y deltas and transmits the shift coordinatesto the scanning program, which in turn executes the shift in thescanning position. In some procedures, a topical cholinergic agonistsuch as pilocarpine hydrochloride ophthalmic solution 2% (e.g., IsoptoCarpine 2% from Alcon, Geneva, Switzerland) may be instilled in thetarget eye prior to treatment to constrict the pupil, flatten out theiris surface, and mitigate changes in the iris size and shape during theprocedure. The line and spot separation between each beam spot may bepredetermined and programmed into the scanning program prior totreatment. In some cases, the spot and line separation place each beamspot tangent to the others throughout the target region. The scanpattern may be raster (including slow-x/fast-y and slow-y/fast-x),spiral (including limbus to pupil and pupil to limbus), vector, andLissajous scans.

In one embodiment, the x-y beam guidance system may scan the beam spotabout the iris surface by means of controlled deflection of the laserbeam. Embodiments utilizing beam steering in two dimensions may drivethe beam spot about the two-dimensional surface of the iris. Beam motionmay be periodic (e.g., as in barcode scanners and resonant galvanometerscanners) or freely addressable (e.g., as in servo-controlledgalvanometer scanners). Exemplary beam steering in two dimensions mayinclude: rotating one mirror along two axes (e.g., one mirror scans inone dimension along one row and then shifts to scan in one dimensionalong an adjacent); and reflecting the laser beam onto two closelyspaced mirrors mounted on orthogonal axes.

There are numerous methods for controlled beam deflection, bothmechanical and non-mechanical. Exemplary non-mechanical methods mayinclude: steerable electro-evanescent optical refractor or SEEOR;electro-optical beam modulation; and acousto-optic beam deflection.Exemplary mechanical methods may include: nanopositioning using apiezo-translation stage; the micro-electromechanical system or MEMScontrollable microlens array; and controlled deflection devices.Mechanically controlled deflection devices may include: motioncontrollers (e.g., motors, galvanometers, piezoelectric actuators, andmagnetostrictive actuators); optical elements (e.g., mirrors, lenses,and prisms), affixed to motion controllers; and driver boards (akaservos) or similar devices to manage the motion controllers. The opticalelements may have a variety of sizes, thicknesses, surface qualities,shapes, and optical coatings, the selection of which depends upon thebeam diameter, wavelength, power, target region size and shape, andspeed requirements. Some embodiments may utilize optical elements thatare flat or polygonal mirrors. An embodiment of the motion controllermay include a galvanometer, including a rotor and stator (to managetorque efficiency) and a position detector (PD) (to manage systemperformance). An exemplary PD may include one or more illuminationdiodes, masks, and photodetectors. Driver boards may be analog ordigital. Scan motion control might also comprise one or more rotaryencoders and control electronics that provide the suitable electriccurrent to the motion controller to achieve a desired angle or phase.The installed scanning program disclosed above may be configured tocollect measured scan and target region data.

The x-y beam guidance system may apply the laser spot to all or anyportion of the anterior iris surface. Treated fractions of the anterioriris surface may include the following (which are inclusive and do nottake into account any spared tissue due to line and/or spotseparations): greater than ¼; greater than 30%; greater than ½; greaterthan ½; and greater than %.

The system can include one or types of rangefinding apparatuses tomeasure the Z distance from a reference point to the target (e.g., theiris surface). As used herein, the Z direction is taken to be thevertical direction, perpendicular to the X-Y plane (e.g., the irissurface). A component referred to herein as optical exit 220 may beprovided to allow the exiting of laser light to reach the eye. Opticalexit 220 may include windows, lenses (e.g., dichroic lenses), mirrors,shutters, or other optical components. In some implementations, thesystem may include platform control 230, which may be configured toprovide coarse adjustment (manually or automatic computer-controlled) inthe X, Y, or Z directions. The platform control 230 may also beconfigured to perform fine adjustments similar to the above, with suchfine adjustments implemented by computer control. Also included in someimplementations are control computer and power supplies, depicted byelement 240 in FIG. 1. Alternatively, control computers or electronicsand some or all of the needed power supplies need not be contained inthe system 200 as depicted in FIG. 1, but may be distributed in otherlocations or networked to be operatively connected to the laser system.Examples of rangefinding apparatuses may include systems that performtriangulation, time-of-flight measurements, etc., with one specificexample being an optical coherence tomography system. Further discussionof rangefinding and/or tracking apparatuses is provide throughout theapplication.

The laser system may deliver a laser in a first direction, which in theexample of FIG. 2 is the Z axis. The control computer system 240 may beadjacent to the laser system and configured to control the laser systemduring the color alteration procedure. By “adjacent,” this means in ahousing of the laser system, in a larger housing that contains the lasersystem and generally encloses the overall device itself, such as shownin FIG. 2. In some embodiments, “adjacent” may be in the treatment roomor nearby treatment room and connected wired or wirelessly to the lasersystem. In some embodiments, the control computer system may include auser interface in a first plane substantially perpendicular to the firstdirection. For example, there may be a display such as a computer screenthat provides information on the laser system, the patient, or thetreatment.

Patient support structure 280 may have a patient support surface 282extending in a second direction that may be substantially perpendicularto the first direction (e.g., in the example of FIG. 2, being in the X-Yplane). The patient support structure may be configured to be adjustableto set a patient position or alignment relative to the laser system. Asused herein, the term “patient position” or “position” means thelocation of the patient's head or eye (e.g., an X, Y, Z coordinate). Asused herein, the term “patient alignment” or “alignment” means theorientation of the patient's head or eye, and may include tilt, roll, orother sort of angular measure that describes the orientation of the eye.As used herein, the term “substantially perpendicular” means that thepatient support surface provides support for the patient such that(optionally in combination with other components such as the headsupport element, described below) the neck muscles may be disengaged.This does not mean that any particular component or fraction ofcomponents of the patient support surface need be strictly perpendicularto the first direction. For example, a patient support surface mayinclude a couch-type structure that may be oriented horizontally or in areclining position (thus substantially perpendicular to the firstdirection). Similarly, in other embodiments described later herein, thepatient support surface may be an adjustable seat (forming part of thepatient support structure), where the seat is generally horizontal forthe patient to sit on.

In some embodiments, the laser system may be immovable such that onlythe patient support surface is configured to position (or orient) thepatient. As shown in FIG. 2, the laser system may be cantilevered overthe patient support surface with the laser beam coming downward towardsthe patient who is located on the patient support surface. However, inother embodiments, such as that shown in FIG. 6, it is contemplated thatlaser system may be below the patient in the sense that laser may bedelivered from below rather than above.

In some embodiments, Z actuator 286 may include (or be part of) coarseadjustment hardware configured to cause automated and/or manualadjustments to the patient support surface in the first direction.Examples of coarse adjustment hardware may include, for example, steppermotors, gear assemblies, band assemblies, etc. Some embodiments may havesimilar coarse adjustment hardware integrated with X-Y actuator 284 forcoarse adjustments in the X-Y plane (i.e., allowing movement of thepatient support surface substantially perpendicular to the firstdirection). While in some embodiments, such coarse adjustment hardwaremay be manual (e.g., movable via rollers, tracks, hand cranks, etc.), insome embodiments a computer may automate and control the coarseadjustment hardware. In some embodiments, the system may generate aprojection of a crosshair or similar reticle to locate where thepatient's head and/or eye should be. The positioning technician (oralternatively the system utilizing machine vision to scan and locate theprojected crosshair on the patient) may then position the patientappropriately before performing optional fine adjustments.

In some embodiments, Z actuator 286 may include (or be part of) fineadjustment hardware configured to cause automated and/or manualadjustments to the patient support surface in the first direction.Examples of fine adjustment hardware may include hydraulic actuators,pneumatic actuators, piezoelectric actuators, etc. Some embodiments mayhave similar fine adjustment hardware integrated with X-Y actuator 284for fine adjustments in the X-Y plane. While most embodiments of fineadjustment hardware may be computer controlled, it is contemplated thatsome embodiments may be manually adjustable (e.g., via high-ratio gearassemblies, etc.).

As used herein, the terms “coarse” and “fine” have their plain meaningin that “coarse” adjustments are of a lower resolution (i.e., largerstep size) than “fine” adjustments. However, examples of coarseresolutions may include 0.5 cm, 1 cm, 2 cm, 5 cm, or 10 cm. Examples of“fine” resolutions may include 0.1 mm, 0.5 mm, 1 mm, 2 mm, or 5 mm. Suchvalues are approximate in that it is understood that physical systemscontain varying degrees of lash or hysteresis that may affect theparticulars of a given resolution. In some embodiments, due to theprecise nature of the disclosed color alteration procedure, fineadjustments made utilizing the fine adjustment hardware may be performedautomatically by the system based on a treatment plan for altering aneye color of the patient. In some embodiments, similar adjustments maybe made utilizing the coarse adjustment hardware. For example, thecoarse adjustment hardware may be controlled by the computer to put thepatient in approximately the correct location. Then, the fine adjustmenthardware may be controlled to exactly position the patient fortreatment. As the treatment progresses, the two types of hardware andtheir respective actuators may work in concert to position the patientas needed.

FIG. 3 shows a simplified patient support structure having an upperreclining portion in accordance with one or more embodiments. Asdepicted in FIG. 3, the patient support structure may include a headsupport element 310 mounted to the upper reclining portion 320 andconfigured to cause a head of the patient 10 to be supported withoutengagement of neck muscles. Examples of head support elements mayinclude, for example, headrests, cradles, padded prongs, etc. The headsupport element may support the head in one or more locations (e.g.,supporting the head at multiple specific points, rather than asingle-piece headrest). In some embodiments, the head support elementmay be independently adjustable in any combination of X, Y, Z as well asany combination of rotation (right or left), tilt (forward or back),etc. Such adjustable embodiments of the head support element may furtherinclude an adjustment mechanism similar to the coarse adjustmenthardware and/or fine adjustment hardware described above. The headsupport element may be set with a similar resolution to that describedabove for coarse and/or fine adjustments. As used herein, “withoutengagement,” “disengaged,” or similar expressions as relating to neckmuscles mean that the muscles are relaxed and providing little, if any,support to the head such that unwanted involuntary patient movement ofthe head and/or eye is reduced or eliminated. As disclosed, this isembodied by systems that allow the person to lean forward or back suchthat the patient support structure is providing support rather than theneck muscles.

As also shown in FIG. 3, the patient support structure may include alower support portion 330 in addition to an upper reclining portion. Theangle between the upper reclining portion and the lower support portionmay be manually or automatically controlled by the physician and/or thecontrol system. In some cases, a balance may be reached between patientcomfort and/or physical needs (e.g., for patients unable to be fully inthe supine position) and disengagement of the neck muscles for thetreatment procedure. There may also be an adjustable leg portion 340connected to the lower support portion 310 to provide for adjusting apatient's legs. This adjustable leg portion 340 is discussed furtherwith reference to FIG. 5.

FIG. 4 shows a view of the simplified patient support structure of FIG.3 with the upper reclining 320 portion fully horizontal in accordancewith one or more embodiments. As described above, exemplary embodimentsof the patient support structure may include ones where the patient isable to fully recline (i.e., the entire patient support surface 282forms a substantially horizontal plane). Also shown in this embodimentis the head support element suitably adjusted such that the patient isin the proper location and alignment for the procedure.

FIG. 5 shows a view of the simplified patient support structure of FIG.3 having an adjustable leg portion 340 in accordance with one or moreembodiments. As shown, the adjustable leg portion may be mounted to thelower support portion. The adjustable leg portion may be adjustable ineither a coarse or fine adjustment manner as described above. Again, itis important in many embodiments for the patient to have disengaged neckmuscles. Due to the interconnectedness of a person's musculoskeletalstructure, even improper positioning of the legs may cause engagement ofmuscles throughout the body, including the neck muscles. As such, insome embodiments, a large number of degrees of freedom may be utilizedin the patient support structure to provide the needed positioning ofthe patient, not just at the head, but in other locations throughout thebody, for proper disengagement of the neck muscles.

FIG. 6 shows a simplified patient support structure 280 with a headsupport element 610 having an aperture 620 in accordance with one ormore embodiments. In some embodiments, the head support element mayinclude an aperture in the patient support surface. The aperture is alsodepicted in the upper inset showing a partial top view of the patientsupport structure. As shown in FIG. 5, the head support element may beconfigured to support the head with the patient in a face-down positionon the patient support surface. To allow access to the patient for theprocedure, the aperture may allow access to the eye by the patient'sface being at least partially within (or through) the aperture. Suchembodiments may be combined with other features described in the presentdisclosure, for example, patient support surfaces that have thecapability of reclining.

In some embodiments, patient support structures may be multifunctionalin that for some patients, a head support element 310 of the sortdepicted in FIGS. 3-5 may be attached to the patient support structureas described above. However, the same patient support structure may havea second head support element 610 in the form of an aperture 620 at alocation in the upper reclining portion 320 such that when in theposition shown in FIG. 6, the aperture 6120 may be utilized rather thanthe (possibly detachable) headrest-type head support element 310. Suchembodiments have the advantage of allowing the patient support structureto interface with both types of laser systems—where the laser isdirected from above or below the patient.

FIG. 7 shows a simplified patient support surface 282 as part of anadjustable seat 720 in accordance with one or more embodiments. Aspreviously mentioned, laser systems may provide laser beams from belowthe patient. As shown in FIG. 7, the patient support structure 280 mayinclude a head support element 710 and an adjustable seat 720. In theexample shown, the patient is leaning forward with their head resting onthe head support element 710 with the eye exposed to the laser beam (inembodiments where the laser system directs the beam from below). Toadjust the position and alignment of the patient, the adjustable seat720 (with patient support surface 282) may be configured to move in thefirst direction as indicated by the double-arrow. Such motion relativeto the head support element may change the tilt of the eye when the headis resting on the head support element. For example, with the adjustableseat at a higher Z position, the patient would naturally be in a morehorizontal, face-down position, which would have the effect of rotatingthe patient's eye about an axis in the X-Y plane. It is alsocontemplated that the head support element and the adjustable seat mayeach also have actuators similar to those described above (e.g., in X,Y, and/or Z and at a fine and/or coarse resolution).

FIG. 8 shows a simplified diagram of a system 800 having laser system210 and image sensor 810 for use in rangefinding in accordance with oneor more embodiments. In conjunction with any of the patient supportsystems disclosed herein, the rangefinder may be utilized for accuratelylocating the eye, and in particular, the location of the iris stroma forthe proper delivery of focused laser light. The rangefinder may includean image sensor that receives optical information about the patientand/or eye and utilizes this information to determine the distanceand/or orientation of the eye relative to a reference point. To addressthe above problem, some implementations of the disclosed methods mayinclude imaging the iris with an image sensor operatively connected to acomputer 812. Examples of image sensors may include an infrared cameraused in conjunction with infrared illumination sources 820. In someembodiments, optical data (e.g., light reflected from the eye) may bedirected to the image sensor via dichroic mirror 814.

Some implementations of the disclosed methods may include utilizing arangefinder as part of the optical tracking system to provide accuratedistances to the target location in the eye. For example, therangefinder may determine a distance between the iris and a referencecomponent of the optical tracking system. Examples of referencecomponents may include the last optical component in the laser system(e.g., a window or lens closest to the patient), a mirror or galvos, orany other component or location in the laser system with a knownlocation to provide a point of reference for the rangefinding.

Based on the determined distance, the system may control the focal pointof the laser beam to remain substantially in focus between an anteriorsurface and posterior surface of the iris, at the stromal pigmenttargeted for removal, or at any of the disclosed possible focusingplanes. Examples of rangefinders may include, for example, triangulationlasers, time of flight detectors, phase shift detectors, ultrasonicdetectors, frequency modulation detectors, interferometers, a camera, ora light sensor.

Triangulation may utilize lasers for distance measurements. Structuralembodiments of exemplary triangulation methods may include threeelements: an imaging device, an illumination source, and either anadditional imaging device or an additional illumination source.Illumination source(s) may include image projectors that project lightimages onto the iris, sclera, or other patient field. Exemplary lightimages might include circles and lines. In one embodiment, the laserbeam may illuminate a point on the surface of the target (e.g., theiris, the sclera, or some other point on the patient's face). Diffuse orspecular reflections from the illuminated point may be monitored with aposition-sensitive detector, which may be placed a given distance fromthe laser source such that the laser source, the target point, and thedetector form a triangle. Assuming the beam incidence angle to thetarget is 0°, the position-sensitive detector identifies the incidenceangle of the detector to the target, and the distance between the lasersource and the detector is known, the distance from the laser source tothe target may be determined with the appropriate trigonometricfunction.

Time-of-flight or pulse measurements may measure the time of flight of aradiation pulse from the measurement device to the target and backagain. Exemplary forms of radiation include light (e.g., near-infraredlaser) and ultrasound. An exemplary time-of-flight apparatus includes aradiation source, a radiation sensor, and a timer. Time of flight may bemeasured based upon timed pulses or the phase shift of an amplitudemodulated wave. In the case of timed pulses, the speed of the radiationis already known, so the timer measures the turnaround time of eachpulse to determine the distance, where distance=(speed of radiation×timeof flight)/2.

The phase shift method may utilize an intensity-modulated laser beam.The phase shift of intensity modulation may be related to the time offlight. Compared with interferometric techniques, its accuracy is lower,but it allows unambiguous measurements over larger distances and is moresuitable for targets with diffuse reflection. For small distances,ultrasonic time-of-flight methods may be used, and the device maycontain an aiming laser for establishing the direction of the ultrasonicsensor, but not for the distance measurement itself.

Frequency modulation methods may include frequency-modulated laserbeams, for example with a repetitive linear frequency ramp. The distanceto be measured may be translated into a frequency offset, which may bemeasured via a beat note of the transmitted and received beam.

Interferometers may be implemented for distance measurements with anaccuracy which is far better than the wavelength of the light used.

Various systems for rangefinding may provide very accurate measurements,for example, determining distances with the resolution of at least 10,200, 500, or 750 μm. Such systems may include, for example, atime-domain optical coherence tomography system, a spectral domainoptical coherence tomography system.

Utilizing the disclosed rangefinding, some methods may utilize the samestructure to include autofocusing the laser system in response tochanges in the determined distance and corresponding shifts in the focalpoint of the beam. Computer systems in communication with the lasersystem may automatically autofocus the laser system and measure adistance to the stromal pigment of the iris at periodic intervals (e.g.,at approximately 1 kHz, 10 kHz, 100 kHz, etc.).

Exemplary methods for lens focusing include manually or electronically(a) shifting the position of one or more focal lenses (e.g., a lensmounted on a motor stage to shift along the beam access), (b) shiftingthe position of one or more focal mirrors (e.g., by adding a thirdmirror to a galvos beam steering system), (c) changing the shape of oneor more focal lenses or mirrors, (d) deflecting or refracting a beam bymeans of an acousto-optical or electro-optical devices, or (e) usingelectrostatic or electromagnetic lenses or mirrors to shift the focalposition of the beam.

Movement of the patient's head and eyes along the z axis can frustrateaccurate range-finding and autofocusing. By positioning the patient suchthat the head is supported and the neck muscles are permitted torelease, z head position changes may be minimized.

Topographical variations in the anterior iris surface may also frustrateaccurate range-finding and autofocusing. These variations resultprimarily from three elements: iris tilt, iris folds, and iris crypts.Iris tilt is a naturally occurring phenomenon. As a result, the irisplane will rarely reside perpendicular to the beam axis. The iris planetilts about both its the horizontal and vertical axes, and can tilt asmuch as 5°, which results in z variations of up to 700 μm from one edgeof the iris to the other (assuming a roughly 11 mm horizontal irisdiameter). An iris tilt system may be utilized to significantly reduceor eliminate this iris surface variation.

Iris folds are also a naturally occurring phenomenon. As the irisdilates, it folds like a drape, concentric to and away from the pupil.These folds can create significant z variations in the iris topography.To significantly reduce or eliminate iris folds, some methods mayinclude introduction of a topical miotic solution, such as Pilocarpineophthalmic solution. In one embodiment, patents may be dosed with 1 dropof 2% Pilocarpine ophthalmic solution 15, 10, and 5 minutes prior to theprocedure to achieve high miosis, resistant to the potentially dilativeeffect of lasing the iris anterior to the iris dilator muscles duringthe procedure. Each patient may also be given 500 mg of acetaminophen(orally) 30 minutes prior to the procedure as a prophylaxis againstheadaches from ciliary body tension.

Iris crypts are another common phenomenon. They are created by spacesbetween the iris stromal fibers. In brown eyes, these crypts aretypically filled with pigment and can therefore be ignored for purposesof the initial treatment sessions. Once the stromal pigment has beensubstantially eliminated outside of the crypts, stromal pigment mightremain in the depths of the iris crypts. Pigment spots occur naturallyin light eyes, so this remaining crypt pigment should not look unnaturaland should barely be noticeable.

If remaining pigment spots bother the patient, the system can remove orreduce the remaining crypt pigment by slightly shifting the beam waistposteriorly into the stroma and rescanning the iris using this shiftedwaist position. This shifted waist setting may also be an optiondisplayed for selection by the operator on the touch screen interface.The distance of the shift of the beam waist may be equal to about 80% ofthe beam DOF to ensure delivery of high fluence within the pigmentedcrypts. If the crypt pigment remains 3-4 weeks after treatment with thisposterior waist shift, this waist shift procedure may be repeated,posteriorly shifting the beam waist each time by another 80% of the DOF,until the crypt pigment is eliminated sufficiently eliminated.

FIGS. 8A and 8B show simplified diagrams of a rangefinder configured forperforming coarse and/or fine resolution measurements in accordance withone or more embodiments. A challenge with conventional patient supportsystems that are integrated into treatment systems is how to efficientlyposition a patient utilizing available rangefinding or positioningsystems. Inefficient systems may be prone to patient positioning error,slow operation, delays in treating multiple patients, or undue wear onmechanical systems such as by using fine adjustment hardware for whatshould be a coarse patient adjustment.

As shown in FIG. 8A, the disclosed systems may include a rangefinder 850configured to have multiple resolutions for use when positioning apatient with the patient support structure, which also has multipleresolutions in patient positioning. For example, the rangefinder can beconfigured to be set to a coarse resolution for determining the distancefor a coarse adjustment of the patient support structure or a fineresolution for determining the distance for a fine adjustment of thepatient support structure. In various embodiments, the coarse resolutionof the rangefinder may be between 2000 microns and 6000 microns and thefine resolution may be between 5 microns to 2000 microns, with otherranges contemplated as within the scope of the present disclosure. Thus,in certain embodiments, the coarse resolution is larger than the fineresolution. As used herein, the term “resolution” (with reference to arangefinder) refers to the smallest window of a distance measurementthat the rangefinder is able to resolve at its current setting. Forexample, if the resolution was 3000 microns, then any given distancemeasurement would have a window of uncertainty of approximately 1500microns on either side of the reported distance measurement. Acorresponding definition is applied to the “resolution” of the patientsupport structure, e.g., as described previously, one may have a coarseresolution of 1 cm and a fine resolution of 1 mm.

The present disclosure contemplates embodiments where the coarse andfine adjustment hardware may be utilized for manual operation, based onthe resolution set on the rangefinder and optionally in conjunction withthe generation of “indications” of patient position to aid the user inpositioning the patient. In one embodiment, the coarse adjustmenthardware may be configured to be manually operated to perform a coarseadjustment based on the resolution set on the rangefinder. Optionally,the system may be configured to generate, during the coarse adjustment,an indication of the position of the anterior iris relative to a targetposition of the anterior iris. As used herein, an “indication” refers toan audio, visual, haptic, or other human-detectable feedback mechanismthat indicates information about the measured distance relative to atarget distance (i.e., where the system is trying to locate the eyeanatomy for treatment). For example, as depicted in FIG. 8A, theindication 860 may be a crosshair projected onto the patient. Otherembodiments of indications may include sounds, a series of lights (e.g.,green then yellow then red), displays at a monitor of an image of thepatient (actual or animated), or calibration markers showing thepatient's proximity to the desired Z position of, for example, thepatient's anterior iris surface to perform the procedure on that iris.Such indications may also be generated in conjunction with the systemperforming X-Y alignment.

Other variations are contemplated for embodiments where the coarseadjustment hardware may be configured to be automatic to perform acoarse adjustment based on the resolution set on the rangefinder. Also,the system may be configured to generate, during the coarse adjustment,an indication of the position of the anterior iris relative to a targetposition of the anterior iris. In such variations, the system may beconfigured to allow a user to initiate an automatic coarse adjustmentafter which the computing systems associated with the rangefinder andthe patient support structure perform the adjustment. Yet anotherembodiment is where the coarse adjustment hardware may be configured tobe automatic and the system may be configured to automatically perform acoarse adjustment, or portion thereof, based on the resolution set onthe rangefinder. While the above features (manual/automatic operation,indication generation, etc.) are described with reference to a coarseadjustment, such may also be performed substantially similarly with thedisclosed fine or ultra-fine adjustments described herein.

Also depicted in FIG. 8A is an “area of interest,” which as used herein,means an area on the patient where one point (e.g., an endpoint) of thedetermined distance is calculated to. FIG. 8A particularly shows oneexample for an area of interest 870 for a coarse adjustment. In thisembodiment, the area of interest is an area surrounding a closed eyelid880 of the patient. As such, in this example, the distance can becalculated from anywhere on the closed eyelid to the reference point inthe rangefinder. For example, the point on the eyelid may correspond tothe center of the illustrated indication (cross-hair), a point midwaybetween the cross-hair and the edge of the area of interest, etc. Otherpossible areas of interest can be, for example, the nasal bridge 890(depicted in FIG. 8A), a forehead, or other part of the patient'sanatomy suitable for providing a known reference point having agenerally known distance relationship to the iris. For example, the Zposition of the highest point on the anterior surface of the nasalbridge might be 1.2-2.5 cm from the Z position of the anterior surfaceof the patient iris, and the Z position of the highest point on theanterior surface of the treatment eyelid might be between 2.5-5.0 mmfrom the Z position of the anterior surface of the patient iris. Thisdata may reside in computer memory and accounted for when analyzing thecoarse Z measurements and predicting the Z position of the anteriorsurface of the iris for fine adjustments. Exemplary sizes of the areasof interest may be 10×10 cm, 5×5 cm, 2×3 cm, 1×1 cm, etc., withappropriate numerical areas based on the shape of the area. The area ofinterest may be any shape, e.g., square, rectangular, oval, orirregular. The area of interest need not be contiguous and may comprisea number of areas having exemplary total areas as given above.

In various embodiments, the rangefinder may also be configured to be setto a fine resolution and the distance being in an area of interest asdescribed above. In certain embodiments, such as when the rangefinder isset to the fine resolution, the area of interest may be smaller thanthat when the rangefinder is set to the coarse resolution. FIG. 8Billustrates such an embodiment. Here, the area of interest 872 is aportion of the patient's iris 110. For fine adjustments, the area ofinterest may typically be smaller, for example, 10×10 mm, 5×5 mm, 2×3mm, 1×1 mm, etc. The area of interest 872 may also be in otherlocations, such as outside the pupil, adjacent the eye, at the fundus(e.g., where the measurement point is made through the pupil to maintainapproximate centering of the area of interest), etc.

Additionally, the system may be further configured to provide what isreferred to herein as “ultra-fine” adjustments. Such ultra-fineadjustments may be undertaken to very precisely position the patient sothe focal plane of the laser is as close as possible to the targetpigment. Such ultra-fine adjustments may be performed after the patientsupport structure has performed coarse and/or fine adjustments. Forexample, the rangefinder may be configured to be set to a coarseresolution or a fine resolution. The system may be configured to performa coarse adjustment of the patient support surface utilizing the coarseadjustment hardware and perform a fine adjustment of the patient supportsurface utilizing the fine adjustment hardware. Additionally, the systemmay be configured to perform an ultra-fine adjustment of an element ofthe laser system. In some embodiments, the element may be a lens of thelaser system (e.g., a lens in optical exit 220), a mirror, laserhardware controlling beam divergence, etc. In one example, performingthe ultra-fine adjustment may include the system adjusting a position ofa lens to reduce a difference between a target distance and the distanceas determined by the rangefinder. For example, this may include moving athird galvos axis (e.g., controlling a Z shift) or the moving a lensmounted on a motor stage. In some embodiments, the system may beconfigured to perform the ultra-fine adjustment with a resolution of 5microns or less.

One example of a method for one of the disclosed embodiments may includethe system initiating a Z-alignment procedure. The system may thenperform a coarse adjustment (rangefinder resolution 3000 microns, areaof interest 2×3 cm, patient support structure moves with a 2 cmresolution (or steps)). The system's computer finds and causes the bestpatient support structure position for the coarse setting (so the focalpoint or plane is within a best 2 cm window—limited by patient supportstructure).

Then, the system may switch to fine adjustment (rangefinder resolution15 microns, area of interest 1×1 mm, patient support structure moves inwith a 10 mm resolution (or steps)). After the fine adjustment, thefocal point is in a 10 mm window—again limited to resolution of supportmovement.

After the fine adjustment, an ultra-fine adjustment may be performed bymoving a lens to bring the focal plane as close as possible to a targetposition in 5 micron steps—but now limited by, e.g., the 15 micronresolution of the rangefinder.

FIG. 9 shows a simplified system 900 including detached physician 910and technician 920 consoles in accordance with one or more embodiments.To allow for control of the procedure, some embodiments of the presentdisclosure may have physician console 910 in communication (e.g., wiredor wirelessly) with the laser system and physically detached (butallowing for wired connections) from the laser system. The physicianconsole may be configured to display patient data including one or moreof patient images, patient medical record data, or patient treatmentdata associated with the color alteration procedure performed by thelaser system. In addition to monitoring data at the physician console,the physician console may also be configured to accept input thatcontrols the laser system and/or the patient support surface. Exemplaryadvantages of the detached aspect of the physician console may includepermitting the physician to have freedom of movement about the treatmentarea while still being able to directly control the procedure. In theexample shown in FIG. 9, the physician may be located near the patient'shead to facilitate communication with the patient as well as to be inthe most optimal position for directly monitoring the procedure. As usedherein, the term “physically detached” means that the console is notrigidly mounted to the laser system or patient support structure. Forembodiments with wireless connectivity, the consoles may be completelylacking physical connection to the above. For embodiments with wiredconnectivity, there may be flexible wires or cables connecting them tothe above, but still allowing substantial freedom to the user of theconsole. The present disclosure also contemplates other embodimentswhere the console may not be “physically detached” as described above,but may be located on an articulated arm (which may or may not beconnected to laser system or patient support structure) and thus allowsubstantially independent position of the console.

Also shown in FIG. 9 is an example of a technician console 920. Here,the technician console is shown positioned near the feet of the patient,for example to not interfere with the physician or to monitor thepatient at a different angle to see things during the procedure that thephysician may not be able to. Also, the technician console may allow thetechnician to be at needed locations proximate the patient for thedelivery of other treatment, for example, injections, monitoring bloodpressure, etc. In some embodiments, the technician console, similar tothe physician console above, may be in communication with the lasersystem but physically detached from the laser system and the physicianconsole. In this way, some embodiments may provide the maximum freedomfor the physician and the technician to be at the optimal locationsduring treatment.

In the context of the present disclosure, which describes embodiments ofsystems for an eye color alteration procedure, the physician console andthe technician console may be configured to be in communication to viewreal-time images and the patient treatment data associated with thecolor alteration procedure. In some embodiments, the physician consolemay be configured to override commands for the laser system that wereinitiated by the technician console. For example, the commands issuedfrom the physician console may override those from the technicianconsole, but the reverse may not be true. In this way, in situationswhere there may be a conflict between commands from the physicianconsole and the technician console, the physician console haspreference.

FIG. 10 shows an illustrative system for performing an eye colorchanging procedure in accordance with one or more embodiments. Forexample, system 1000 may represent the components used for performing aneye color changing procedure. For example, system 1000 may power a localdevice to perform an eye color changing procedure where the requireddetermination (e.g., iris mapping, pattern to follow, laser power todeliver, identification of patient, alignment of patient, etc.) aredetermined remotely and/or in the cloud. As shown in FIG. 10, system1000 may include user terminal 1022 and user terminal 1024. While shownas personal computers, in FIG. 10, it should be noted that user terminal1022 and user terminal 1024 may be any computing device, including, butnot limited to, a laptop computer, a tablet computer, a hand-heldcomputer, other computer equipment (e.g., a server), including “smart,”wireless, wearable, and/or mobile devices. FIG. 10 also includes cloudcomponents 1010. Cloud components 1010 may alternatively be anycomputing device as described above and may include any type of mobileterminal, fixed terminal, or other device. For example, cloud components1010 may be implemented as a cloud computing system and may feature oneor more component devices. It should also be noted that system 1000 isnot limited to three devices. Users may, for instance, utilize one ormore other devices to interact with one another, one or more servers, orother components of system 1000. It should be noted that, while one ormore operations are described herein as being performed by particularcomponents of system 1000, those operations may, in some embodiments, beperformed by other components of system 1000. As an example, while oneor more operations are described herein as being performed by componentsof user terminal 1022, those operations may, in some embodiments, beperformed by components of cloud components 1010. In some embodiments,the various computers and systems described herein may include one ormore computing devices that are programmed to perform the describedfunctions. Additionally, or alternatively, multiple users may interactwith system 1000 and/or one or more components of system 1000. Forexample, in one embodiment, a first user and a second user (e.g., atechnician and a physician) may interact with system 1000 using twodifferent components.

With respect to the components of user terminal 1022, user terminal1024, and cloud components 1010, each of these devices may receivecontent and data via input/output (hereinafter “I/O”) paths. Each ofthese devices may also include processors and/or control circuitry tosend and receive commands, requests, and other suitable data using theI/O paths. The control circuitry may comprise any suitable processingcircuitry. Each of these devices may also include a user input interfaceand/or user output interface (e.g., a display) for use in receiving anddisplaying data. For example, as shown in FIG. 10, both user terminal1022 and user terminal 1024 include a display upon which to display data(e.g., information related to an eye color changing procedure).

Additionally, as user terminal 1022 and user terminal 1024 are shown astouchscreen smartphones, these displays also act as user inputinterfaces. It should be noted that in some embodiments, the devices mayhave neither user input interface nor displays and may instead receiveand display content using another device (e.g., a dedicated displaydevice such as a computer screen and/or a dedicated input device such asa remote control, mouse, voice input, etc.). Additionally, the devicesin system 1000 may run an application (or another suitable program). Theapplication may cause the processors and/or control circuitry to performoperations related to an eye color changing procedure.

Each of these devices may also include electronic storages. Theelectronic storages may include non-transitory storage media thatelectronically stores information. The electronic storage media of theelectronic storages may include one or both of (i) system storage thatis provided integrally (e.g., substantially non-removable) with serversor client devices or (ii) removable storage that is removablyconnectable to the servers or client devices via, for example, a port(e.g., a USB port, a firewire port, etc.) or a drive (e.g., a diskdrive, etc.). The electronic storages may include one or more ofoptically readable storage media (e.g., optical disks, etc.),magnetically readable storage media (e.g., magnetic tape, magnetic harddrive, floppy drive, etc.), electrical charge-based storage media (e.g.,EEPROM, RAM, etc.), solid-state storage media (e.g., flash drive, etc.),and/or other electronically readable storage media. The electronicstorages may include one or more virtual storage resources (e.g., cloudstorage, a virtual private network, and/or other virtual storageresources). The electronic storages may store software algorithms,information determined by the processors, information obtained fromservers, information obtained from client devices, or other informationthat enables the functionality as described herein.

FIG. 10 also includes communication paths 1028, 1030, and 1032.Communication paths 1028, 1030, and 1032 may include the Internet, amobile phone network, a mobile voice or data network (e.g., a 10G or LTEnetwork), a cable network, a public switched telephone network, or othertypes of communications network or combinations of communicationsnetworks. Communication paths 1028, 1030, and 1032 may separately ortogether include one or more communications paths, such as a satellitepath, a fiber-optic path, a cable path, a path that supports Internetcommunications (e.g., IPTV), free-space connections (e.g., for broadcastor other wireless signals), or any other suitable wired or wirelesscommunications path or combination of such paths. The computing devicesmay include additional communication paths linking a plurality ofhardware, software, and/or firmware components operating together. Forexample, the computing devices may be implemented by a cloud ofcomputing platforms operating together as the computing devices.

Cloud components 1010 may be a database configured to store user datafor a user. For example, the database may include user data that thesystem has collected about the user through prior operations and/orprocedures. Alternatively, or additionally, the system may act as aclearing house for multiple sources of information about the user. Cloudcomponents 1010 may also include control circuitry configured to performthe various operations needed to perform an eye color changingprocedure.

Cloud components 1010 include machine learning model 1002. Machinelearning model 1002 may take inputs 1004 and provide outputs 1006. Theinputs may include multiple data sets such as a training data set and atest data set. Each of the plurality of data sets (e.g., inputs 1004)may include data subsets related to user data, an eye color changingprocedure, patient progress, and/or results. In some embodiments,outputs 1006 may be fed back to machine learning model 1002 as input totrain machine learning model 1002 (e.g., alone or in conjunction withuser indications of the accuracy of outputs 1006, labels associated withthe inputs, or with other reference feedback information). In anotherembodiment, machine learning model 1002 may update its configurations(e.g., weights, biases, or other parameters) based on the assessment ofits prediction (e.g., outputs 1006) and reference feedback information(e.g., indication of accuracy, results of procedure, reference labels,and/or other information). In another embodiment, where machine learningmodel 1002 is a neural network, connection weights may be adjusted toreconcile differences between the neural network's prediction and thereference feedback. In a further use case, one or more neurons (ornodes) of the neural network may require that their respective errorsare sent backward through the neural network to facilitate the updateprocess (e.g., backpropagation of error). Updates to the connectionweights may, for example, be reflective of the magnitude of errorpropagated backward after a forward pass has been completed. In thisway, for example, the machine learning model 1002 may be trained togenerate better predictions (e.g., predictions related to an appropriateiris mapping to use, pattern to follow, laser power, level of eye colorchange, number of procedures, length of procedures, etc.

In some embodiments, machine learning model 1002 may include anartificial neural network. In such embodiments, machine learning model1002 may include an input layer and one or more hidden layers. Eachneural unit of machine learning model 1002 may be connected with manyother neural units of machine learning model 1002. Such connections maybe enforcing or inhibitory in their effect on the activation state ofconnected neural units. In some embodiments, each individual neural unitmay have a summation function which combines the values of all of itsinputs together. In some embodiments, each connection (or the neuralunit itself) may have a threshold function such that the signal mustsurpass before it propagates to other neural units. Machine learningmodel 1002 may be self-learning and trained, rather than explicitlyprogrammed, and may perform significantly better in certain areas ofproblem solving, as compared to traditional computer programs. Duringtraining, an output layer of machine learning model 1002 may correspondto a classification of machine learning model 1002 and an input known tocorrespond to that classification may be input into an input layer ofmachine learning model 1002 during training. During testing, an inputwithout a known classification may be input into the input layer, and adetermined classification may be output.

In some embodiments, machine learning model 1002 may include multiplelayers (e.g., where a signal path traverses from front layers to backlayers). In some embodiments, back propagation techniques may beutilized by machine learning model 1002 where forward stimulation isused to reset weights on the “front” neural units. In some embodiments,stimulation and inhibition for machine learning model 1002 may be morefree flowing, with connections interacting in a more chaotic and complexfashion. During testing, an output layer of machine learning model 1002may indicate whether or not a given input corresponds to aclassification of machine learning model 1002 (e.g., an eye color changerequested, a pattern to follow, a laser power to deliver, alignment ofpatient, etc.).

FIG. 11 shows a process for supporting and aligning a patient during acolor alteration procedure in accordance with one or more embodiments.For example, process 1200 (e.g., via one or more components of FIGS.2-10) may represent the steps taken by one or more devices as shown inFIGS. 2 and 8 ahead of or during an eye color changing procedure. Forexample, the system may need to align a patient with a laser systemprior to a procedure. Furthermore, the system may need to ensure thepatient is aligned and the patient's neck muscles are not engaged (e.g.,to prevent head movement during a procedure).

At step 1110, process 1100 (e.g., via one or more components of FIGS.2-10) adjust a position of patient support surface. For example, inorder to prevent head movement, the patient support surface may comprisea surface extending in a direction that is substantially perpendicularto a direction of a laser delivered from the laser system. To ensurealignment before, during, and/or after (e.g., in order to allow apatient to exit) the procedure, the support structure may be adjustable(e.g., via controls entered into a user interface of a computer systemand/or through manual adjustment through mechanical means) to set apatient position or alignment relative to the laser system. For example,the system may adjust the position of the support structure using courseand fine adjustment hardware.

At step 1120, process 1100 (e.g., via one or more components of FIGS.2-10) adjust a position of patient support surface. For example,additionally or alternatively to the adjustment of the patient supportsurface, the system may also adjust a position of the laser system. Forexample, the system may adjust the position of the laser system toensure that using one or more automatic and/or manual adjustment means.In some embodiments, the adjustment of the laser system may includeadjustments based on information from optical tracking systems and/orrangefinder systems. For example, before and/or during the procedure thesystem may automatically adjust the laser system in order to perform theeye color procedure.

At step 1130, process 1100 (e.g., via one or more components of FIGS.2-10) determine whether a patient is aligned with the laser system. Forexample, the system may first automatically determine that a patient isin a correct location and/or has a correct location before continuingwith the process. In some embodiments, the determination may be based onthe direction of laser light and a position of an iris of the user(e.g., as described in FIGS. 1-2).

At step 1140, process 1100 (e.g., via one or more components of FIGS.2-10) indicates proper alignment on a user interface. For example, thesystem may generate one or more notifications (e.g., on a user interfacefor physician 910 and technician 920 as shown in FIG. 9). In responseto, or in additional to, the system generating the notification, thesystem may enable the procedure to continue.

FIG. 12 shows a process for allowing the performance of an eye colorchanging procedure in accordance with one or more embodiments. In someembodiments, the system may also include an image sensor to acquire ascan of the patient's iris or retina. Such scans may be utilized toensure patient identity and/or a proper medical condition prior to thebeginning of an eye color alteration procedure, with the patient datadisplayed for the physician. For example, process 1200 (e.g., via one ormore components of FIGS. 2-10) may represent the steps taken by one ormore devices as shown in FIGS. 2 and 8 ahead of or during an eye colorchanging procedure.

At step 1210, process 1200 (e.g., via one or more components of FIGS.2-10) captures a first scan. For example, an image sensor may capturethe first scan at a first time prior to the altering of the eye color.The first scan may be of at least one of an iris or retina of thepatient.

At step 1220, process 1200 (e.g., via one or more components of FIGS.2-10) captures a second scan with the image sensor and at a second timelater than the first time and prior to the altering of the eye color,the second scan being of at least one of the iris or the retina of thepatient. For example, the first scan may be done as part of aconsultation exam or other pre-procedure scan. The second scan may, forexample, be taken shortly before the procedure or even at the start ofthe procedure to confirm the identity of the patient as described in thenext steps.

At step 1230, process 1200 (e.g., via one or more components of FIGS.2-10) compares the first scan captured at the first time with the secondscan captured at the second time. Software as described in FIG. 10 mayperform the comparison. For example, the machine learning algorithms maybe trained from a patient library of iris patterns and/or retinalpatterns (e.g., which may contain the first scan) to recognize thepatterns of a particular patient.

At step 1240, process 1200 may (e.g., via one or more components ofFIGS. 2-10) determine an identity of the patient based on matching thefirst scan captured at the first time with the second scan captured atthe second time. For example, the trained algorithm described above mayuse the second scan as input and determine the identity of the patientand/or a confidence value of a match.

At step 1250, process 1200 may (e.g., via one or more components ofFIGS. 2-10) generate, for display on a user interface, a confirmation ofthe identity of the patient. The confirmation may be in the form ofgraphical and/or textual output at the display. The confirmation mayinclude, for example, a patient's name, medical record number, or otherpersonal identifying information.

At step 1260, process 1200 may (e.g., via one or more components ofFIGS. 2-10) retrieve patient medical record data based on the first scanor the second scan. For example, medical databases may be accessed viathe networked computing systems disclosed in FIG. 10. With the confirmedidentity, such access may be more readily obtained from secure medicalrecord databases. For example, in some embodiments, the patient medicalrecord data may include a treatment plan for delivery by the lasersystem.

At step 1270, process 1200 (e.g., via one or more components of FIGS.2-10) displays, at the physician console, the patient medical recorddata based on the iris scan. Similar to step 1260, the patient medicalrecord data may be in the form of textual and/or graphical informationrepresentative of the patient's medical records. This may include, forexample, the patient's current or past medical condition, informationabout past and/or the current color alteration procedure, etc.Accordingly, in some embodiments, the system may enable the laser systemto deliver the treatment plan based on the first scan or the second scancorresponding to patient identification included with the patientmedical record data.

The above-described embodiments of the present disclosure are presentedfor purposes of illustration and not of limitation, and the presentdisclosure is limited only by the claims which follow. Furthermore, itshould be noted that the features and limitations described in any oneembodiment may be applied to any other embodiment herein, and flowchartsor examples relating to one embodiment may be combined with any otherembodiment in a suitable manner, done in different orders, or done inparallel. In addition, the systems and methods described herein may beperformed in real time. It should also be noted that the systems and/ormethods described above may be applied to, or used in accordance with,other systems and/or methods.

The present techniques will be better understood with reference to thefollowing enumerated embodiments:

Embodiment 1: A system for supporting and aligning a patient during acolor alteration procedure, the system comprising: a laser system forperforming the color alteration procedure, wherein the laser systemdelivers a laser in a first direction; a control computer systemadjacent to the laser system for controlling the laser system during thecolor alteration procedure, the control computer system comprising auser interface in a first plane substantially perpendicular to the firstdirection; and a patient support structure comprising: a patient supportsurface extending in a second direction that is substantiallyperpendicular to the first direction and configured to be adjustable toset a patient position or alignment relative to the laser system; coarseadjustment hardware configured to cause automated and/or manualadjustments to the patient support surface in the first direction; andfine adjustment hardware configured to cause automated fine adjustmentsto the patient support surface in the first direction based oninstructions received from the control computer.

Embodiment 2: The system of any of the preceding embodiments, thepatient support structure comprising a head support element configuredto cause a head of the patient to be supported without engagement ofneck muscles.

Embodiment 3: The system of any of the preceding embodiments, thepatient support structure comprising a lower support portion and anupper reclining portion, the head support element mounted to the upperreclining portion and the head support element is adjustable to set thepatient position or alignment.

Embodiment 4: The system of any of the preceding embodiments, thepatient support surface further comprising an adjustable leg portionmounted to the lower support portion.

Embodiment 5: The system of any of the preceding embodiments, the headsupport element comprising an aperture in the patient support surface,the head support element is configured to support the head with thepatient in a face-down position on the patient support surface and theaperture allowing access to the eye.

Embodiment 6: The system of any of the preceding embodiments, thepatient support structure comprising an adjustable seat configured tomove in the first direction relative to the head support element suchthat the movement changes the tilt of the eye when the head is restingon the head support element.

Embodiment 7: The system of any of the preceding embodiments, whereinthe coarse adjustment hardware is further configured to move the patientsupport surface substantially perpendicular to the first direction.

Embodiment 8: The system of any of the preceding embodiments, the coarseadjustment hardware being a manual adjustment system that is configuredto adjust the patient position to be in a direction substantiallyparallel to an optical axis of the laser system.

Embodiment 9: The system of any of the preceding embodiments, the fineadjustment hardware comprising a hydraulic system configured to causeadjustment of the patient support surface with a resolution of 10millimeters or less.

Embodiment 10: The system of any of the preceding embodiments, whereinfine adjustments utilizing the fine adjustment hardware are performedautomatically by the system based on a treatment plan for altering aneye color of the patient.

Embodiment 11: The system of any of the preceding embodiments, furthercomprising an optical tracking system includes a rangefinder, the methodfurther comprising determining, utilizing the rangefinder, a distancebetween the iris and a reference component of the optical trackingsystem.

Embodiment 12: The system of any of the preceding embodiments, whereinthe distance is determined with a resolution of at least 10 microns.

Embodiment 16: The system of any of the preceding embodiments, whereinthe rangefinder is a time-domain optical coherence tomography system ora spectral domain optical coherence tomography system.

Embodiment 17: The system of any of the preceding embodiments, whereinthe reference component is a last lens in the optical tracking system.

Embodiment 18: The system of any of the preceding embodiments, furthercomprising autofocusing the laser system in response to the distance.

Embodiment 19: The system of any of the preceding embodiments, theautofocusing comprising: measuring a distance to the stromal pigment ofthe iris at periodic intervals; and controlling, based on the distance,the laser system to remain substantially in focus between an anteriorsurface and posterior surface of the iris.

Embodiment 20: The system of any of the preceding embodiments, whereinthe rangefinder comprises one or more of: triangulation lasers, time offlight detectors, phase shift detectors, ultrasonic detectors, frequencymodulation detectors, interferometers, a camera, or a light sensor.

Embodiment 21: The system of any of the preceding embodiments, whereinthe rangefinder is configured to be set to a coarse resolution fordetermining the distance for a coarse adjustment of the patient supportstructure or a fine resolution for determining the distance for a fineadjustment of the patient support structure.

Embodiment 22: The system of any of the preceding embodiments, whereinthe coarse resolution is between 2000 microns and 6000 microns and thefine resolution is between 5 microns to 2000 microns.

Embodiment 23: The system of any of the preceding embodiments, whereinthe coarse adjustment hardware is configured to be manually operated toperform a coarse adjustment based on the resolution set on therangefinder and the system is configured to generate, during a coarseadjustment, an indication of the position of the anterior iris relativeto a target position of the anterior iris.

Embodiment 24: The system of any of the preceding embodiments, whereinthe coarse adjustment hardware is configured to be automatic to performa coarse adjustment based on the resolution set on the rangefinder andthe system is configured to generate, during a coarse adjustment, anindication of the position of the anterior iris relative to a targetposition of the anterior iris.

Embodiment 25: The system of any of the preceding embodiments, whereinthe coarse adjustment hardware is configured to be automatic and thesystem is configured to automatically to perform a coarse adjustmentbased on the resolution set on the rangefinder.

Embodiment 26: The system of any of the preceding embodiments, therangefinder configured to be set to a coarse resolution or a fineresolution and the distance being in an area of interest, wherein whenthe rangefinder is set to the coarse resolution the area of interest islarger than that when the rangefinder is set to the fine resolution.

Embodiment 27: The system of any of the preceding embodiments, whereinthe coarse adjustment hardware is configured to be manually operated toperform a coarse adjustment based on the resolution set on therangefinder and the system is configured to generate, during the coarseadjustment, an indication of the position of the anterior iris relativeto a target position of the anterior iris.

Embodiment 28: The system of any of the preceding embodiments, whereinthe coarse adjustment hardware is configured to be automatic to performa coarse adjustment based on the resolution set on the rangefinder andthe system is configured to generate, during a coarse adjustment, anindication of the position of the anterior iris relative to a targetposition of the anterior iris.

Embodiment 29: The system of any of the preceding embodiments, whereinthe coarse adjustment hardware is configured to be automatic and thesystem is configured to automatically perform a coarse adjustment basedon the resolution set on the rangefinder.

Embodiment 30: The system of any of the preceding embodiments, therangefinder configured to be set to a coarse resolution or a fineresolution, the system configured to: perform a coarse adjustment of thepatient support surface utilizing the coarse adjustment hardware;perform a fine adjustment of the patient support surface utilizing thefine adjustment hardware; and perform an ultra-fine adjustment of anelement of the laser system.

Embodiment 31: The system of any of the preceding embodiments, whereinthe element is a lens and performing the ultra-fine adjustment comprisesadjusting a position of the lens to reduce a difference between a targetdistance and the distance as determined by the rangefinder.

Embodiment 32: The system of any of the preceding embodiments whereinthe system is configured to perform the ultra-fine adjustment with aresolution of 5 microns or less.

Embodiment 33: The system of any of the preceding embodiments, whereinthe laser system does not move such that only the patient supportsurface is configured to position the patient.

Embodiment 34: The system of any of the preceding embodiments, whereinthe laser system is cantilevered over the patient support surface.

Embodiment 35: The system of any of the preceding embodiments, furthercomprising: a physician console in communication with the laser systemand physically detached from the laser system, wherein the physicianconsole is configured to display patient data including one or more ofpatient images, patient medical record data, or patient treatment dataassociated with the color alteration procedure performed by the lasersystem.

Embodiment 36: The system of any of the preceding embodiments, thephysician console further configured to accept input at the physicianconsole that controls the laser system and/or the patient supportstructure.

Embodiment 37: The system of any of the preceding embodiments, furthercomprising a technician console in communication with the laser systemand physically detached from the laser system and the physician console.

Embodiment 38: The system of any of the preceding embodiments, whereinthe physician console and the technician console are configured to be incommunication to view real-time images and the patient treatment dataassociated with the color alteration procedure.

Embodiment 39: The system of any of the preceding embodiments, whereinthe physician console is configured to override commands for the lasersystem that were initiated by the technician console.

Embodiment 40: The system of any of the preceding embodiments, furthercomprising an image sensor and a non-transitory, machine-readable mediumstoring instructions which, when executed by at least one programmableprocessor, cause the at least one programmable processor to performoperations comprising: capturing a first scan with an image sensor andat a first time prior to the altering of the eye color, the first scanbeing of at least one of an iris or retina of the patient; capturing asecond scan with the image sensor and at a second time later than thefirst time and prior to the altering of the eye color, the second scanbeing of at least one of the iris or the retina of the patient;comparing the first scan captured at the first time with the second scancaptured at the second time; determining an identity of the patientbased on matching the first scan captured at the first time with thesecond scan captured at the second time; generating for display, on auser interface, a confirmation of the identity of the patient;retrieving patient medical record data based on the first scan or thesecond scan; and displaying, at a physician console, the patient medicalrecord data based on the iris scan.

Embodiment 41: The system of any of the preceding embodiments, theoperations further comprising: retrieving a treatment plan for deliveryby the laser system; and enabling the laser system to deliver thetreatment plan based on the first scan or the second scan correspondingto patient identification included with the patient medical record data.

A tangible, non-transitory, machine-readable medium storing instructionsthat, when executed by a data processing apparatus, cause the dataprocessing apparatus to perform operations comprising those described inany of the above system embodiments 1-41.

A method comprising operations described in any of the above systemembodiments 1-41.

What is claimed is:
 1. A system for supporting and aligning a patientduring a color alteration procedure, the system comprising: a lasersystem for performing the color alteration procedure, wherein the lasersystem delivers laser light in a first direction to perform the coloralteration procedure; a control computer system connected to the lasersystem for controlling the laser system during the color alterationprocedure; and a patient support structure comprising: a patient supportsurface extending in a second direction that is substantiallyperpendicular to the first direction and configured to be adjustable toset a patient position or alignment relative to the laser system; fineadjustment hardware configured to cause automated fine adjustments tothe patient support surface in the first direction based on instructionsreceived from the control computer; and a non-transitory,machine-readable medium storing instructions which, when executed by thecontrol computer system, cause the control computer system to performoperations comprising automatically performing fine adjustmentsutilizing the fine adjustment hardware based on a treatment plan foraltering an eye color of the patient during the color alterationprocedure.
 2. The system of claim 1, the patient support structurecomprising a head support element configured to cause a head of thepatient to be supported without engagement of neck muscles.
 3. Thesystem of claim 2, the patient support structure comprising a lowersupport portion and an upper reclining portion, the head support elementmounted to the upper reclining portion and the head support element isadjustable to set the patient position or alignment.
 4. The system ofclaim 1, wherein patient support structure further comprises coarseadjustment hardware configured to cause automated and/or manualadjustments to the patient support surface in the first direction, andwherein the coarse adjustment hardware is further configured to move thepatient support surface substantially perpendicular to the firstdirection or the coarse adjustment hardware being a manual adjustmentsystem that is configured to adjust the patient position to be in adirection substantially parallel to an optical axis of the laser system.5. The system of claim 1, the fine adjustment hardware comprising ahydraulic system configured to cause adjustment of the patient supportsurface with a resolution of 10 millimeters or less.
 6. The system ofclaim 1, further comprising an optical tracking system that includes arangefinder utilized to determine a distance between the iris and areference component of the optical tracking system.
 7. The system ofclaim 6, wherein the distance is determined with a resolution of atleast 750 microns.
 8. The system of claim 6, further comprisingautofocusing the laser system in response to the distance.
 9. The systemof claim 8, the autofocusing comprising: measuring a distance to thestromal pigment of the iris at periodic intervals; and controlling,based on the distance, the laser system to remain substantially in focusbetween an anterior surface and posterior surface of the iris.
 10. Thesystem of claim 6, wherein the rangefinder is configured to be set to acoarse resolution for determining the distance for a coarse adjustment,using coarse adjustment hardware configured to cause automated and/ormanual adjustments to the patient support surface in the firstdirection, of the patient support structure or a fine resolution fordetermining the distance for a fine adjustment of the patient supportstructure.
 11. The system of claim 10, wherein the coarse resolution isbetween 2000 microns and 6000 microns and the fine resolution is between5 microns to 2000 microns.
 12. The system of claim 10, wherein thecoarse adjustment hardware is configured to be manually operated toperform a coarse adjustment based on the resolution set on therangefinder and the system is configured to generate, during the coarseadjustment, an indication of the position of the anterior iris relativeto a target position of the anterior iris.
 13. The system of claim 10,wherein the coarse adjustment hardware is configured to be automatic toperform a coarse adjustment based on the resolution set on therangefinder and the system is configured to generate, during the coarseadjustment, an indication of the position of the anterior iris relativeto a target position of the anterior iris.
 14. The system of claim 10,wherein the coarse adjustment hardware is configured to be automatic andthe system is configured to automatically perform a coarse adjustmentbased on the resolution set on the rangefinder.
 15. The system of claim6, the rangefinder configured to be set to a coarse resolution or a fineresolution and the distance being in an area of interest, wherein whenthe rangefinder is set to the coarse resolution the area of interest islarger than that when the rangefinder is set to the fine resolution. 16.The system of claim 10, wherein the coarse adjustment hardware isconfigured to be manually operated to perform a coarse adjustment basedon the resolution set on the rangefinder and the system is configured togenerate, during the coarse adjustment, an indication of the position ofthe anterior iris relative to a target position of the anterior iris.17. The system of claim 10, wherein the coarse adjustment hardware isconfigured to be automatic to perform a coarse adjustment based on theresolution set on the rangefinder and the system is configured togenerate, during a coarse adjustment, an indication of the position ofthe anterior iris relative to a target position of the anterior iris.18. The system of claim 10, wherein the coarse adjustment hardware isconfigured to be automatic and the system is configured to automaticallyperform a coarse adjustment based on the resolution set on therangefinder.
 19. The system of claim 6, the rangefinder configured to beset to a coarse resolution or a fine resolution, the system configuredto: perform a coarse adjustment of the patient support surface utilizingcoarse adjustment hardware; perform a fine adjustment of the patientsupport surface utilizing the fine adjustment hardware; and perform anultra-fine adjustment of an element of the laser system.
 20. The systemof claim 19, wherein the system is configured to perform the ultra-fineadjustment with a resolution of 5 microns or less.
 21. The system ofclaim 1, further comprising: a physician console in communication withthe laser system and physically detached from the laser system, whereinthe physician console is configured to display patient data includingone or more of patient images, patient medical record data, or patienttreatment data associated with the color alteration procedure performedby the laser system.
 22. The system of claim 21, the physician consolefurther configured to accept input at the physician console thatcontrols the laser system and/or the patient support structure.
 23. Thesystem of claim 21, further comprising a technician console incommunication with the laser system and physically detached from thelaser system and the physician console.
 24. The system of claim 23,wherein the physician console and the technician console are configuredto be in communication to view real-time images and the patienttreatment data associated with the color alteration procedure.
 25. Thesystem of claim 24, wherein the physician console is configured tooverride commands for the laser system that were initiated by thetechnician console.
 26. The system of claim 1, further comprising animage sensor and wherein the operations further comprise: capturing afirst scan with an image sensor and at a first time prior to thealtering of the eye color, the first scan being of at least one of aniris or retina of the patient; capturing a second scan with the imagesensor and at a second time later than the first time and prior to thealtering of the eye color, the second scan being of at least one of theiris or the retina of the patient; comparing the first scan captured atthe first time with the second scan captured at the second time;determining an identity of the patient based on matching the first scancaptured at the first time with the second scan captured at the secondtime; generating for display, on a user interface, a confirmation of theidentity of the patient; retrieving patient medical record data based onthe first scan or the second scan; and displaying, at a physicianconsole, the patient medical record data based on the iris scan.
 27. Thesystem of claim 26, the operations further comprising: retrieving atreatment plan for delivery by the laser system; and enabling the lasersystem to deliver the treatment plan based on the first scan or thesecond scan corresponding to patient identification included with thepatient medical record data.